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Stanford CA-1 Guide > Monitors > Flashcards

Monitors Flashcards

1
Q

How must we measure oxygenation (3)

A
  • FiO2 analyzer
  • Low [O2] alarm
  • Pulse ox w/ variable pitch tone
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2
Q

How must we measure ventilation (2)

A
  • Continuous capnography

- Disconnect alarm for vent

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3
Q

How must we measure circulation (3)

A
  • EKG (3 or 5 leads)
  • Blood pressure q5m
  • ONE continuous measurement (pulse ox, a line, palpable pulse, auscultation, doppler)
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4
Q

When must we monitor temp

A

If significant changes are anticipated

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5
Q

How does pulse ox determine oxygenation?

A
  • Light emitted at 660 (red, Hb) and 940 (infrared, HbO2) -> measures light absorbed
  • Absorption during DC flow (non-pulsatile) is removed (aka venous, capillary, tissue flow)
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6
Q

How is SpO2 calculated?

A

S value = (AC/DC 660)/(AC/DC 940)

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7
Q

Why is a pulse ox not on a patient 85%?

A

1:1 ratio S value = 85%

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8
Q

Methemoglobin - how does SpO2 read?

A
  • Approaches 85% (similar absorption at both wavelengths)
  • Will appear falsely low if it’s actually > 85
  • Will appear falsely high if it’s actually < 85
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9
Q

Carboxyhemoglobin - how does SpO2 read?

A

Falsely high (reads similar to HbO2)

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10
Q

What causes falsely low SpO2? (6)

A
  • blue/green dyes
  • blue nail polish
  • shivering/motion
  • ambient light
  • low perfusion (low CO, anemia, hypothermia, etc)
  • Mal-positioned sensor
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11
Q

SaO2 vs SpO2

A

SaO2 = HbO2 / ALL Hb

SpO2 = HbO2/(Hb + HbO2)

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12
Q

Things that DON’T affect SpO2

A
  • Bilirubin
  • HbF/HbS/SuHb
  • acrylic nails
  • flourescein dye (yellow-green)
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13
Q

When is cyanosis clinically seen?

A

With 5 g/dl desaturated Hb

  • At Hb 15 -> 80% SpO2
  • At Hb 9 -> 66% SpO2
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14
Q

Best lead for P waves and sinus rhythm

A

II

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15
Q

How to monitor for anterior ischemia w/ 3-lead EKG

A

Move L arm to V5 position, monitor lead I

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16
Q

Where does V5 lead go?

A

L anterior axillary line, 5th ICS

17
Q

5-lead EKG - what can be monitored?

A

7 simultaneous leads

18
Q

5-lead EKG - how to detect ischemia? (3) (least-most sensitive)

A
  • V5 = 75%
  • II + V5 = 80%
  • II + V4 + V5 = 98%
19
Q

How does NIBP work?

A

Measures oscillations in blood flow across different cuff pressures
– loudest oscillation pressure = MAP

20
Q

Indications for invasive BP monitor (5)o a

A
  • Moment-to-moment BP changes
  • Planned pharm or mechanical manipulation
  • Repeated blood sampling
  • Failure of NIBP
  • Measure volume status (via pulse pressure)
21
Q

How does SBP and MAP change in aorta vs peripheral?

A
  • SBP higher in periphery 2/2 reflected waves

- MAP is unchanged b/c higher SBP is offset by more time at diastolic pressure (“narrowing of systolic pressure wave”)

22
Q

How does BP change based on vertical height?

A

pH = 7.410

Change in pressure (p) of 7.4 mmHg for every 10cm of height (H) difference

23
Q

Up-sloping end tidal trace

A

Bronchospasm

24
Q

Significant hypotension can lead to a ___ in EtCO2

A

Decrease

25
Q

EtCO2 and PaCO2 in pulmonary embolism

A

Decreased EtCO2, but PaCO2 decreases more (hence, increased A-a gradient)

26
Q

EtCO2 goal in CPR

A

> 10

27
Q

Exhausted CO2 absorbant…EtCO2?

A

Does not return to 0-5

28
Q

Apnea…EtCO2 trend?

A

Up 6 in first minute, then up 3 every minute after

29
Q

Gold standard temperature location

A

Pulmonary artery

30
Q

Tympanic membrane temp

A

Correlates w/ core well, approximates brain temp

31
Q

Nasopharynx temp

A

Correlates well w/ core and brain

32
Q

Oropharynx temp

A

Correlates well w/ core, tympanic, and esophagus

33
Q

Esophagus temp

A

Correlates well w/ core

34
Q

Bladder temp

A

Accurate when urine flow is high, but may be delay from core temp

35
Q

Axillary temp

A

Inconsistent, varies by skin temp/perfusion

36
Q

Rectal temp

A

Not accurate, affected by stool and venous blood and enteric organisms

37
Q

Skin temp

A

Inaccurate, varies by site

38
Q

Primary mode of heat loss

How do anesthetics cause heat loss?

A

Radiation (60%)

Vasodilation

Stanford CA-1 Guide (2 decks)

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